2.   Diabetic retinopathy is the number one cause of legal blindness in the country in patients under 64.

3.  If you have diabetes, you must realize that it could affect your eyes.  You won't have problems just because you are a diabetic (many diabetics have none), but you should be aware that they can exist.

4.  The part of the eye affected by diabetes is called the retina.  Think of the eye as a hollow ball built like a camera.  The retina lines the back of the eye, and a clear gel (the vitreous) fills the eye like air fills the hollow ball.  Visual images are formed on the retina much like on the film in a camera.

Diabetes damages the retina by affecting its blood vessels.  Some vessels become plugged, while others leak fluid.  Less commonly, abnormal blood vessels grow along the front surface of the retina and into the vitreous.   Bleeding into the eye (vitreous hemorrhage) from these newly formed blood vessels and scarring or detachment of the retina are the main ways diabetes causes severe impairment of vision.  Blurring of vision may also be caused by fluid leaking out of the damaged blood vessels, which produces a thickened retina (i.e., macular edema).   These and other less severe changes are all included in the term diabetic retinopathy.

5.  Regular eye examinations and appropriate therapy (laser photocoagulation) have been shown by scientific studies to prevent visual loss in many cases.

Laser treatment (photocoagulation) uses powerful light rays directed into the eye and focuses on a tiny spot on the retina.  The light produces heat, which cauterizes or seals off the abnormal blood vessels.  Photocoagulation is not painful and is usually performed as an outpatient procedure.

There is now clear evidence that laser treatment reduces the risk of blindness in certain patients with certain stages of diabetic retinopathy.  Cases with severe bleeding into the vitreous or detachment of the retina may require major eye surgery called vitrectomy.

6.  The diabetic patient should be aware that such eye symptoms as blurry or decreased vision, floaters, flashing lights, distorted vision, etc., may indicate serious eye disease.  Fluctuating eye vision may indicate changes in blood sugar levels and may require better blood sugar control by the doctor treating your diabetes.

7.  Diabetic patients should plan to have periodic eye examinations by a health care professional.  The following information underscores the importance of routine periodic eye exams.

• Severe diabetic retinopathy occurs more commonly in patients who have had diabetes for a longer period of time (i.e., 10 or 20 years).   However, diabetic retinopathy can also occur early.
• The level and quality of diabetic control is probably related to the severity of the retinopathy in younger onset (Type I) diabetics.
• The severity of the diabetic retinopathy may not be related to the degree of other complications (e.g., kidney, neurological, etc.).
• The exact duration of the diabetes is usually unknown when diabetes is diagnosed in an adult.
• Diabetics have been shown to have a significantly increased incidence of other eye diseases (e.g., cataracts and glaucoma).
• The diabetic patient may have normal vision with no symptoms and yet have significant diabetic retinopathy (e.g., proliferative diabetic retinopathy) with imminent danger of blinding complications (e.g., vitreous hemorrhage).

8.  In view of this, a patient with diabetes should be seeing their eye care professional annually.  The Cincinnati Eye Institute offers screening exams with several insurance companies.  The concept behind this examination is to provide an available means of screening diabetic patients for visual acuity, glaucoma screening, cataract, and diabetic retinopathy.  The ophthalmologist evaluating the photographs will determine the need and frequency for future exams.